Episode 155: How Trauma Becomes Biology: Harvard's 100,000 Women Study

"Resilience isn't just coping. It's making more of your life." 

—  Dr. Karestan Koenen

We've been told time heals all wounds. Go back to work. Stay busy. But what if decades of stress are still rewriting the body right now? Dr. Karestan Koenen, a Harvard researcher who has followed 100,000 women over twenty years, shares what she's discovered about how unaddressed trauma doesn't fade—it becomes biology. In this conversation, we explore why major disease studies have ignored trauma, how stalking affects women's heart health, and what epigenetics reveals about catching these changes early.

In this episode you'll learn:

• [01:54] The Pattern No One Was Tracking: How clinical observation at the VA revealed PTSD and diabetes worsening together—before research proved it

• [04:04] Stalking and Heart Disease: Why women on the editorial board said "of course this is true" while men said "there's no way"

• [05:35] The Gap in Major Disease Studies: Why the cohorts that shaped our understanding of diet, exercise, and disease never measured trauma

• [11:27] How to Define Trauma: Uncontrollable, unpredictable, and overwhelming—and why the pandemic qualified

• [14:41] When Coping Mechanisms Take a Toll: How the adaptations that helped us survive can interfere with where we want to go

• [17:14] Resilience Redefined: Why you can have symptoms and still be making meaning—and why the person in front of you is always a survivor

• [23:58] Loss of Life Purpose: How retirement, death of a spouse, or role changes directly impact physical health and longevity

• [28:47] Time Doesn't Heal—It Becomes Biology: Why going back to work and staying busy doesn't make trauma fade

• [32:33] The Biology of Adversity Project: How epigenetics research may catch changes before chronic conditions develop

• [34:17] Somatic Practices Without the Story: The future of yoga, breathwork, and body-based approaches for resetting the nervous system

Main Takeaways

• PTSD and Physical Disease Move Together: Twenty years of research following 100,000 women reveals PTSD and conditions like diabetes and cardiovascular disease are interrelated—when one worsens, so does the other.

• If You Don't Ask, You Can't Analyze: Most major cohort studies that shaped our understanding of diet, exercise, and disease never included trauma measures, leaving a massive gap in what we know about chronic illness.

• Coping Mechanisms Have an Expiration Date: What once protected us—avoidance, hypervigilance, staying busy—can take a toll on the body over time and interfere with where we want to go.

• Resilience Includes Struggle: Resilience means not just managing symptoms, but creating something more—finding purpose, meaning, or contribution even while navigating difficult experiences. You can have both.

• Meaning Keeps Us Alive: Loss of life purpose—through retirement, death of a spouse, or role changes—directly impacts physical health and longevity. When our organizing principle disappears, the body responds.

• Epigenetics Opens New Doors: Our DNA is set at conception, but how genes express is responsive to environment. This means earlier intervention becomes possible before chronic conditions manifest.

• Community Is Medicine: Social support after traumatic events is profoundly protective—yet our modern world increasingly disrupts relationship continuity, leaving people isolated even when surrounded by others.

Notable Quotes

"If you don't ask the question, you can't do the analysis." — Dr. Karestan Koenen

"Coping mechanisms help people survive. Then there's a point at which they take a toll on the body." — Dr. Karestan Koenen

"The person in front of you survived. You're always working with a resilient survivor—no matter what they're experiencing in that moment." — Dr. Karestan Koenen

"Our DNA sequence is set at conception, but epigenetics is responsive to the environment." — Dr. Karestan Koenen

"Time doesn't heal. It makes trauma become biology." — Dr. Aimie

Episode Takeaway

Dr. Koenen's research confirms what I teach. Unaddressed trauma doesn't fade with time. It becomes biology.

Her team followed over 100,000 women for decades. They documented how trauma shows up in the body long after the event. PTSD connects to increased cardiovascular disease risk. Even stalking correlates with heart disease. And yet major disease studies still don't assess trauma. They track diet, exercise, smoking. Almost none assess trauma.

What her work also shows is that struggle and healing can exist together. You don't have to wait until symptoms disappear to begin. Both can be true at the same time. Your body adapted to protect you. Now it can learn something new.

The next time you notice your body holding tension from something long past, pause. That's information. Your body is telling you what it's still carrying.

Resources/Guides:

• Biology of Trauma book - Available now everywhere books are sold. Get your copy

• Free Guide: How Trauma Shows Up in the Body & What To Do About It - Understand why your body responds this way. Learn what helps. 

Related Podcast Episodes:

• Episode 86: Is Trauma Genetic or Epigenetic? Insights with Dr. Bruce Lipton

• Episode 116: The Body Keeps Score: How Trauma Rewires Your Nervous System with Dr. Bessel van der Kolk

About the Guest: Dr. Karestan Koenen is a Professor of Psychiatric Epidemiology at Harvard T.H. Chan School of Public Health and Director of the Broad Trauma Initiative at the Broad Institute of MIT and Harvard. Her research focuses on why some people develop PTSD while others remain resilient, and how trauma alters long-term physical health and accelerates aging. She co-authored Treating Survivors of Childhood Abuse and Interpersonal Trauma: STAIR Narrative Therapy and also teaches yoga and breathwork.

Your host: Dr. Aimie Apigian, double board-certified physician (Preventive/Addiction Medicine) with master's degrees in biochemistry and public health, and author of the national bestselling book "The Biology of Trauma" (foreword by Gabor Maté) that transforms our understanding of how the body experiences and holds trauma. After foster-adopting a child during medical school sparked her journey, she desperately sought for answers that would only continue as she developed chronic health issues. Through her practitioner training, podcast, YouTube channel, and international speaking, she bridges functional medicine, attachment and trauma therapy, facilitating accelerated repair of trauma's impact on the mind, body and biology.

How Trauma Becomes Biology: What 20 Years of Research Shows

A month after I transitioned my adopted son to another family, I developed chronic fatigue and autoimmunity. I remember lying there thinking, "I don't know who I am anymore." My life had lost its meaning. My body responded to that loss in ways I never expected.

That experience taught me something medicine hadn't. Unaddressed loss doesn't fade with time. It becomes biology. When I met Dr. Karestan Koenen, a Harvard researcher who has spent twenty years studying trauma's impact on physical health, I finally understood why.

What she's found offers important insights into what happens when difficult experiences go unaddressed. In this episode, we explore how experiences like stalking change heart health, why major disease studies have ignored trauma, and what epigenetics reveals about catching these changes early.

The Physician's Observation: When PTSD and Diabetes Move Together

Dr. Koenen began her career at the Boston VA Hospital. She worked with women veterans. Many had experienced military sexual trauma. She noticed something that changed the direction of her research.

The women she treated for PTSD also had physical health problems. These problems seemed to move together. As the PTSD got worse, the diabetes got worse. When the diabetes flared, it triggered more PTSD symptoms. This pattern appeared again and again.

At the time, there wasn't research showing this connection. So she brought her clinical observation into research. Twenty years later, her studies have confirmed what she saw in those exam rooms. Trauma doesn't just affect our mental health. It affects our physical health too.

What the Research Reveals About Stalking and Heart Disease

One of Dr. Koenen's recent studies looked at non-contact violence. She studied stalking—the kind that leads to restraining orders. The findings were published in Circulation, a leading heart disease journal.

Women who experienced stalking had higher rates of cardiovascular disease. The editorial board's response tells us something important. The women on the board said, "Of course this is true." The men said, "There's no way this can be true." They published the paper anyway. They included an editorial acknowledging the divide.

This reaction shows how far we still need to go. The connection between trauma and physical disease isn't self-evident to everyone. Even with decades of research supporting it.

Why Major Disease Studies Have Ignored Trauma

Here's something that surprised me. The large cohort studies that shaped what we know about diet, physical activity, and smoking? Most of them never assessed trauma. If you don't ask the question, you can't do the analysis.

Dr. Koenen's former student documented this gap. Studies looking at aging populations have never included measures of anything we would conceptualize as trauma. This explains why the medical system still struggles to connect the dots. The research foundation simply wasn't there.

Individual physicians often recognize the connection immediately. When I talk with clinicians, they say, "Of course. I see this all the time." But systemically, the acknowledgment isn't there yet. The change may need to come from patients asking better questions.

Defining Trauma: Uncontrollable, Unpredictable, Overwhelming

Dr. Koenen's definition of trauma has broadened over twenty years. She describes it as something experienced as uncontrollable, unpredictable, and overwhelming to the ability to cope. These characteristics help explain why so many experiences create lasting effects.

The pandemic had all these qualities. It was uncontrollable and unpredictable. For many people, it overwhelmed the ability to cope. And unlike other collective trauma, it removed the very thing that helps us heal. Social support. After 9/11, Dr. Koenen lived in Manhattan with her siblings. She describes the profound sense of community and pulling together. They went to each other's homes for dinner every night. The pandemic denied us this. Connection became a potential threat. Our bubbles were small. People outside felt threatening.

Coping Mechanisms: Adaptive Until They Take a Toll

Every person in front of us is a survivor. Dr. Koenen shared this perspective from her clinical work. Whatever coping mechanisms helped someone get through their trauma were adaptive at the time. They helped that person survive.

The problem comes later. These mechanisms either take a toll on the body or no longer fit what we want for our lives. A woman she treated could only leave her house at night. This had been adaptive in her original situation. But it interfered with where she wanted to go as a young adult.

The body copes with trauma too. Hypervigilance is adaptive in a threatening environment. But sustained over years, it creates allostatic load. That's the toll that living chronically with these coping mechanisms takes. This is exactly what we see in medicine.

Working with Different Parts of Ourselves

Dr. Koenen mentioned newer models like Internal Family Systems. These explicitly acknowledge different aspects of self. The terrified part exists. So does the angry part. The part that acts out in ways that create shame. But none of these are all of who we are.

I was excited to see a published study using this approach with rheumatoid arthritis patients. Just allowing open communication with parts—asking what the pain would say if it could speak—created measurable changes. This is so different from hating the pain, wanting it gone, shoving it away.

Being explicit about parts helps us honor the terrified aspect. At the same time, we recognize it's not all of us. We can speak to the fearful part or the angry part. We can talk to our pain rather than fighting against it constantly.

Resilience Isn't the Opposite of Symptoms

In research, resilience means having adapted psychologically after adversity. That includes lower levels of PTSD, depression, and anxiety that don't interfere with life. But it also includes something positive—purpose, optimism, a sense of contribution.

Here's what Dr. Koenen shared that struck me. The negative symptoms and the positive function aren't opposites. They run on almost separate tracks. Someone can have significant PTSD symptoms and still be making meaning. Still finding purpose. Still moving forward.

This understanding changed how I work with people. When someone comes in saying they're a failure, that they're broken—I see the resilient self that brought them through the door. Speaking to that resilience shifts the entire conversation.

Why Meaning and Purpose Protect Physical Health

The research on purpose and longevity is clear. People who feel they contribute in some way have better health outcomes. This contribution can take many forms. Religious meaning. Family roles. Community involvement. What matters is that the person feels their life has meaning.

This explains the risk around retirement. When work was the organizing principle for someone's life, losing it can be devastating. The same pattern appears after losing a spouse. Beyond the grief, there's the loss of purpose tied to that relationship.

When Dr. Koenen described this, my stomach knotted. After losing my role as a mother to my adopted son, I felt exactly this. I didn't know who I was anymore. My life had been organized around being a mom. That title, that position—losing it threw me into inner chaos. A month later, my body responded with chronic fatigue and autoimmunity.

Epigenetics: Catching Trauma's Effects Before Disease Develops

Dr. Koenen's current research focuses on epigenetics. Our DNA is set at conception. That alphabet doesn't change. But epigenetics influences how genes are expressed. She described it like musical notes versus the annotations telling musicians to play slowly, quickly, or loudly.

What's exciting is that epigenetics responds to environment. Everything from smoking to touch and trauma changes how our genes are expressed. Dr. Koenen's team is developing methods to look at these changes dynamically, at the cellular level.

The goal is catching these changes earlier. Before they manifest as chronic inflammatory conditions. If we can identify when the biology starts to shift, we might address it before full disease develops. This represents where the field is heading.

Why Somatic Practices Matter for Trauma and Physical Health

Dr. Koenen is also bringing together her scientific training with her personal practice. She teaches yoga and breath work. She's passionate about studying how somatic practices reset the body. She's particularly interested in approaches where people don't even need to talk about the trauma.

This aligns with what I've seen in creating body-based practices. The key is getting people safely into the body without opening Pandora's box. Titrated approaches that are so gentle, people aren't afraid of what they're feeling. The wave that comes isn't overwhelming.

Many of us who've used these practices have experienced the reset. Now we're building the research to understand why. How do breath work and trauma-informed yoga affect long-term health? These questions are finally getting the attention they deserve.

The Gap Between Individual Clinicians and Systemic Change

Individual physicians often get it immediately. When I share these ideas with clinicians, they recognize what they've seen in practice. But systemically, the medical establishment hasn't caught up. The acknowledgment isn't there at a structural level.

Another concerning trend: fewer people have a regular primary care physician. Even those who go to appointments often see a different person every time. There's no relationship history. Less trust. People are less likely to bring up difficult experiences. The family doctor who knew our history is becoming rare.

This mirrors broader social changes. We've moved toward more disruption in relationships. Less continuity. People used to live in the same town, know their neighbors, have that community. Now we can be surrounded by people and still feel isolated.

How to Apply This Research to Our Healing Journey

Understanding how trauma becomes biology changes how we approach healing. Here are ways to apply these insights.

Immediate actions:

1. Consider the timeline. When did physical symptoms first appear? What was happening in life at that time? Look for connections between difficult experiences and health changes.

2. Assess purpose and meaning. What gives life meaning right now? If we've experienced major transitions, how has our sense of purpose shifted? This isn't about forcing meaning—it's about noticing what's already there.

3. Evaluate coping mechanisms. Which ones served us during difficult times? Are any now taking a toll on the body or limiting where we want to go?

4. Explore somatic practices gently. Start with breath work, trauma-informed yoga, or body-based approaches that feel safe. The goal is connection, not catharsis.

5. Build continuity in healthcare relationships. When possible, see the same provider who can track patterns over time. Bring up the connections we're noticing between life experiences and health.

This research offers hope. If trauma becomes biology, then addressing it at the biological level can create real change. We don't have to wait for the medical system to catch up.

Helpful Research

1. Trauma and Cardiovascular Disease in Women Koenen, K.C., et al. (2024). Circulation. Dr. Koenen's team published research showing that women who experienced stalking had higher rates of cardiovascular disease. This study demonstrates that experiences creating chronic threat affect physical health outcomes. The findings appeared in Circulation, a leading cardiology journal.

2. PTSD and Physical Health Pathways Sumner, J.A., et al. (2017). "Post-Traumatic Stress Disorder and Physical Health." Circulation. Research examining how PTSD connects to cardiovascular and metabolic disease. The pathways include inflammation, neuroendocrine changes, and health behaviors. Understanding these connections helps explain why mental and physical health move together.

3. Purpose in Life and Health Outcomes Cohen, R., et al. (2016). "Purpose in Life and Its Relationship to All-Cause Mortality and Cardiovascular Events." Psychosomatic Medicine, 78(2), 122-133. This meta-analysis found that higher purpose in life was associated with reduced mortality and cardiovascular events. The protective effect remained significant even after controlling for other factors.

Listen to Episode 155 →

Disclaimer

This podcast is for educational purposes only and is not a substitute for professional medical or mental health advice, diagnosis, or treatment. The information shared reflects my clinical expertise and research, but every person's biology and healing journey is unique. Always consult with qualified healthcare providers before making changes to your treatment plan or starting new interventions. If you're experiencing a mental health crisis, please contact emergency services or a crisis helpline immediately.

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